Academic Associate Program - PED 5900: Clinical Research & Methods I

PED 5900 Student Application

Please complete the following form by the listed due date (available on our website). Late submissions will only be considered if there are still seats available.

Effective for the fall 2021 semester, all students must attend advising prior to their application being accepted and starting the class. You can click here to sign-up for a group advising session. If these do not work with your schedule, you can email PedResearchEducation@hsc.utah.edu.

Any questions can be directed to PedResearchEducation@hsc.utah.edu.

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* 1. Which semester are you applying for?

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* 2. Basic Contact & Education Information

Last Name

First Name

Middle Name

Preferred Name

Student ID

Umail (all program communication is conducted through Umail)

Phone

Major

Current GPA

Career Path (pre-med, nursing, grad school, etc)

Anticipated Graduation Date (This course is for Junior & Senior-level students)

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* 3. Please select your preferred pronouns:

she/her/hers

he/him/his

they/their

Other (please specify)

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* 4. I have met with the minor's academic advisor. Please note that advising is required for all students before you can apply and be accepted into the class.

Yes

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* 5. Do you have any previous research experience of any kind? (Please note, you don't need research experience as a prerequisite for the course, it is just helpful for us to know how many students enter the program with no previous experience).

Yes

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* 6. If yes, please briefly describe:

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* 7. I am interested in taking this course for:

4 credits (two 3-hour shifts/week)

5 credits (three 3-hour shifts/week)

6 credits (four 3-hours shifts/week)

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* 8. I understand that I will be expected to commit to and keep a regular shift schedule.

Yes

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* 9. A significant portion of the course takes place during students' weekly clinical research shifts at Primary Children's Hospital. Primary Children's Hospital's COVID vaccine policy states that all students must receive the vaccine to take part in learning activities at the hospital, with no exemptions or exceptions. I understand that, per the policy at Primary Children's Hospital, failure to receive the COVID vaccine will prevent me from taking part in this class.

Yes

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* 10. I am available to attend mandatory orientation (always the Friday BEFORE classes start).

Yes

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* 11. I understand that there are requirements to complete BEFORE orientation day in order to participate in this class.

Yes

Academic Associate Program - PED 5900: Clinical Research & Methods I

PED 5900 Student Application

Question Title

* 1. Which semester are you applying for?

Question Title

* 2. Basic Contact & Education Information

Question Title

* 3. Please select your preferred pronouns:

Question Title

* 4. I have met with the minor's academic advisor. Please note that advising is required for all students before you can apply and be accepted into the class.

Question Title

* 5. Do you have any previous research experience of any kind? (Please note, you don't need research experience as a prerequisite for the course, it is just helpful for us to know how many students enter the program with no previous experience).

Question Title

* 6. If yes, please briefly describe:

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* 7. I am interested in taking this course for:

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* 8. I understand that I will be expected to commit to and keep a regular shift schedule.

Question Title

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* 10. I am available to attend mandatory orientation (always the Friday BEFORE classes start).

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* 11. I understand that there are requirements to complete BEFORE orientation day in order to participate in this class.

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* 12. In a paragraph, explain why you are interested in this class?

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* 13. In a paragraph, how will this class/minor help you with reaching your goals?

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* 14. How did you first hear about us? Please be specific.

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* 15. Comments